Furthermore! I’m at the HCR is OK Corral!

This week I am in Denver at a different kind of Health Care Reform rally. Community Health Coalition activists from across the nation are meeting with one another and with the bureaucrats who write and enforce the regs. We are learning how health care reform regulations will be rolled out, what they will mean for our country, and how to incorporate them into our organizing practice.

This is not a sign-waving rally like the beautiful event I attended in DC on October 2nd. We are sitting, not marching. We are eating copious amounts of food and drinking copious amounts of coffee. We take our coffee with acronyms (which the typical coalition coordinator slings back faster than Jesse James could down a shot of whiskey).

I am at the annual conference of Communities Joined in Action, or CJA. The conference is called “Health Reform: Mobilizing for Change.” On Wednesday, I attended a special break out session about how coalitions can make use of new hospital IRS reporting rules to build bigger, better, more effective and more diverse coalitions. (They were introduced because 1% of our nation’s “non-profits” control 66% of its revenue. And most of this 1% were hospital chains. A few Senators wanted to make sure they were really non-profits…) Yesterday, I presented at a workshop about outcome-based storytelling as a mobilization tool.

We’re health care geeks and we’re on the march!

Last year’s CJA conference in Austin set a record with 100 people in attendance. This year, we have doubled our ranks. There are 213 very excited participants. They come from almost every state. Yesterday I ate lunch with a couple of muckety-mucks from HRSA. I spoke to a CDC bureaucrat over a break. But the most exciting presentation of all came from a high-ranking official at CMS, the Center for Medicaid and Medicare Services, the largest insurance agency in the world. For some reason, they dropped an M from their acronym. Maybe someone at CMS got too many brown ones and decided to punish Mars candy.

Throughout most of my career as a health care activist and bureaucrat, CMS were the people you avoided. They were the imperial stormtroopers and their director was Darth Vader. If they came to town, it was to audit your hospital and your county government to make sure they weren’t finding any creative ways to serve the uninsured. You hid under your desk and quaked in fear.

Yesterday, a high-ranking CMS official (the kind of guy who wouldn’t give a health coalition the time of day before 2008) described (with relish) the complete culture change his agency has undergone. He used mostly four number words too profane to repeat although many began with the number 3 (patient safety) or 6 (I forget). There were hundreds of them.

They were the new regs being rolled out that he promised would lay the foundation for what might one day become (I kid you not) “Medicare for All.”

There was also a set of regs he couldn’t name because they have not been published. He apologized for not speaking directly about them. They were so secret that if he told us about them he might have to kill us. Just kidding. CMS will not not allow him to speak because they want to make sure these new regs are not unduly influenced by nefarious individuals trying to undermine them for profit at the expense of public health.

The most exciting change he mentioned at CMS was its switch to a population health model. In past decades, the good folks at CMS were mostly accountants and bean-counters. You could talk until you were blue in the face about the need to reform a particular practice in order to improve a community’s overall health. They didn’t care. They didn’t speak that language. They weren’t concerned with health care outcomes and they wouldn’t have given up a single bean for a community.

But after January of 2008, they brought in talented new people who began to look at risks faced by Medicare beneficiaries and one of the most glaring risks turned out to be a visit to the hospital. Hospitals were extremely dangerous places to be. An outrageous number of Medicare beneficiaries admitted to hospitals were seriously injured by mistakes (I think it was about a third…he threw out numbers like a machine gun). As a result, CMS drafted an entirely new set of regulations aimed at preventing hospital readmissions. Hospitals will be penalized if too high a percentage of their patients are repeatedly readmitted.

This is not a sinister campaign against cancer victims. This is meant to cause hospitals, who have hitherto refused to worry about primary care and prevention, to partner with communities to insure that those at risk for chronic disease are treated, and that those who suffer from chronic disease such as diabetes, heart disease and asthma learn to manage their illnesses. It keeps the population healthy. Hence, the focus on “population health.”

Imagine that. CMS is promoting tobacco cessation.

The CDC (Center for Disease Control) is following suit with a series of grants designed to help communities to create local markets for healthy food, promote nutritious meals in schools, and safe walking and biking paths.

There is really only one vehicle that can cause these types of transformational activities to occur: community health coalitions. Communities that bring together all stakeholders to prevent hospital readmissions by improving community health will be encouraged. But empowering communities in this fashion also builds and strengthens a movement because it builds that movement into the fabric of our society.

Last night, one of the speakers asked us how many had ever heard of the Civil Rights Act of 1957. Only two or three hands went up and they belonged to the older ones amongst us.

In 1957, during the Eisenhower years, a civil rights act was introduced in the Senate and filibustered by Strom Thurmond who read to Senators on cots from his mother’s cook book. What ultimately passed was not the transformative civil rights bill we remember, but one that laid the foundation for that bill to be built.

So, I ask you again…who’s discouraged???? Certainly not the people at this conference. We are happy because we have work ahead of us!

5 Comments

NCrissieB
on October 8, 2010 at 10:27 am

What a wonderful report, Lauren. It sounds like there is more good news on health care than most of us realize. So much of good (or bad!) government happens below the media radar, in which regulations get implemented, how they’re interpreted, and whether they are enforced.

As you note, during the Bush years the CMC’s cultural ethos was to minimize community health spending that might actually help people (or as they called it, “waste”) in favor of spending that lined the pockets of preferred insurers and providers (or as they called it, “no-it’s-not-fraud”). No wonder you hid under your desk whenever they came to town.

Changing that culture – while invisible in our media – can make a huge difference in whether real people do or do not get the health care they need.

winterbanyan
on October 8, 2010 at 10:58 am

This is so exciting, Lauren. It sounds as if HIR has really “let the horse out of the barn” and as if the horses have been hoping for it, just waiting to surge at the first opportunity.

This is a whole new way of looking at health care. I’ll be honest, I never understood why insurance companies weren’t all over prevention and self-management from the start. It would save them money to have healthier insureds. Seems logical to me, but apparently not to them. They preferred to roll the dice and hope that nothing went wrong, and then when it did opted to provide less and less care, and pay fewer and fewer bills.

This is definitely an exciting outlook, especially for the future of my children. Thanks for the good news!

JanF
on October 8, 2010 at 4:44 pm

I am sure that this would never happen 🙄

new regs are not unduly influenced by nefarious individuals trying to undermine them for profit at the expense of public health.

I never even knew what CMS was until I helped a friend sort out the bills for an end-of-life Medicare medical situation for her father. I do remember one thing that seemed utterly ridiculous. Because of the rules, when her dad needed to be moved to a different care unit, he had to be discharged and re-admitted because of some kind of Medicare hospital stay limit. So she had to get him in her car, take him to a short term care facility for an overnight stay and then get him re-admitted. He was post-surgical so every step of the way was the fear that he would open up his wound or just tip over (he was also Stage 3 cancer and not able to eat).

It seems like the things with numbers and codes and rules need to be suspended and a “Person in Charge of Making Sure the Absurd Does Not Occur” should take over. One per hospital…looking for Teh Stoopid and intervening to fix it.

winterbanyan
on October 9, 2010 at 7:27 am

Okay, that’s truly beyond enough. To have to take a sick person out of the hospital overnight because some bean counter has put a limit on the stay… Agh. I plain don’t get it.

But I seem not to get a lot of things these days. Either I’m sinking into senility, or the world has grown slightly mad.

JanF
on October 9, 2010 at 12:00 pm

I vote for the world having gone mad…we can quibble over the “slightly” part.